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中华腔镜泌尿外科杂志(电子版) ›› 2017, Vol. 11 ›› Issue (06) : 393 -397. doi: 10.3877/cma.j.issn.1674-3253.2017.06.009

所属专题： 文献；

临床研究

保留肾单位术与根治性肾切除术对肾功能影响的比较
晁流1, 刘宁2, 甘卫东2,†(), 蔡维奇3, 郭宏骞2   
  1. 1. 210008　南京，南京大学医学院附属鼓楼医院泌尿外科；223800　江苏，南京鼓楼医院集团宿迁市人民医院泌尿外科
    2. 210008　南京，南京大学医学院附属鼓楼医院泌尿外科
    3. 223800　江苏，南京鼓楼医院集团宿迁市人民医院泌尿外科
  • 收稿日期:2017-01-04 出版日期:2017-12-01
  • 通信作者: 甘卫东
  • 基金资助:
    国家自然科学基金面上项目(81572512，81572519)

Comparison of the postoperative renal function between nephron-sparing surgery and radical nephrectomy

Liu Chao1, Ning Liu2, Weidong Gan2,†(), Weiqi Cai3, Hongqian Guo2   

  1. 1. Department of Uology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China; Department of Urology, Suqian People's Hospital, Jiangsu 223800, China
    2. Department of Uology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
    3. Department of Urology, Suqian People's Hospital, Jiangsu 223800, China
  • Received:2017-01-04 Published:2017-12-01
  • Corresponding author: Weidong Gan
  • About author:
    Corresponding author: Gan Weidong, Email: .
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引用本文：

晁流, 刘宁, 甘卫东, 蔡维奇, 郭宏骞. 保留肾单位术与根治性肾切除术对肾功能影响的比较[J]. 中华腔镜泌尿外科杂志(电子版), 2017, 11(06): 393-397.

Liu Chao, Ning Liu, Weidong Gan, Weiqi Cai, Hongqian Guo. Comparison of the postoperative renal function between nephron-sparing surgery and radical nephrectomy[J]. Chinese Journal of Endourology(Electronic Edition), 2017, 11(06): 393-397.

目的

比较保留肾单位手术和根治性肾切除手术治疗早期局限性肾癌术后肾功能的变化，同时探讨不同的肾功能指标在临床中的指导作用。

方法

回顾性分析了南京鼓楼医院2013年6月至2014年10月期间63例早期肾肿瘤患者的临床资料和术后随访资料。35例患者接受保留肾单位术（保肾组），28例患者行根治性肾切除术（根治组），所有的患者均随访满两年，随访期间患者的血肌酐、尿酸、估算肾小球滤过率、胱抑素C、尿微量白蛋白及尿β2微球蛋白被搜集并记录下来。

结果

63例患者术后肾功能均有不同程度的变化，术后早期肾功能的损伤表现更为明显。随着随访时间的延长，大部分患者肾功能可逐渐恢复。保肾组术后急性肾功能不全的发生率为34%，根治组急性肾功能不全的发生率为79%，两组差异具有统计学意义（P<0.01）。术后总体随访结果显示估测肾小球滤过率、胱抑素C及β2微球蛋白变化差异具有统计学意义（P<0.05），而血肌酐、尿酸及尿微量白蛋白差异无统计学意义。虽然两组的尿酸及微量白蛋白水平差异无统计学意义，但保肾组的平均水平低于根治组。在术后肾功能异常的早期检测方面，各指标的独立检测阳性率均较低，尤其是血肌酐、尿酸及估测肾小球滤过率等传统肾功能指标。当各指标互相联合后，肾功能异常的检测阳性率明显提高，保肾组及根治组的联合检测阳性率分别达37.1%和71.4%。

结论

在早期局限性肾肿瘤的治疗中，保留肾单位手术较根治性手术对患者肾功能的损伤更小。胱抑素C、尿微量白蛋白、尿β2微球蛋白对于发现术后肾功能的早期异常更敏感，可与肌酐、尿酸、估测肾小球滤过率起协同作用。

关键词: 肾细胞肿瘤, 肾切除术, 肾功能
Objective

To compare the changes of renal function in patients with early localized renal cell carcinomaafter nephron sparing surgery and radical nephrectomy, and to explore the guiding role of different renal function indexes in clinical practice.

Methods

Clinical data and postoperative follow-up data of 63 patients with early renal tumor who received treatment in Nanjing Gulou Hospital between June 2013 and October 2014 were analyzed retrospectively. A total of 35 patients underwent nephron sparing surgery (Group NSS); 28 patients underwent radical nephrectomy (Group RN), and all the patients were followed up for two years. In addition, serum creatinine, uric acid, estimated glomerular filtration rate, cystatin C, urinary microalbumin and urinary β2microglobulin of these patients were collected and recorded during the follow-up period.

Results

Renal function of the 63 patients changed in different degrees after operation, and damaged more obviously in the early stage. With the extension of follow-up length, renal function of most patients could recover gradually. The incidence rate of postoperative acute renal insufficiency was 34%in Group NSS and 79% in Group RN, which presented statistically significant differences (P<0.01). The overall postoperative follow-up results showed there were statistically significant differencesin changes of estimated glomerular filtration rate, cystatin C and β2microglobulin (P<0.05), but no statistically significant differences in serum creatinine, uric acid and urinary microalbumin. Although levels of uric acid and microalbumin presented no statistically significant differences between the two groups, the average level in Group NSS was lower than that of Group RN. Early detection results of postoperative renal dysfunction showed the positive rate of independent detection of all indexes was low, especially the serum creatinine, uric acid, estimated glomerular filtration rate and other traditional renal function indexes. When the indexes were combined, the positive rate of renal dysfunction was significantly improved, and the combined positive rate was 37.1% and 71.4% in Group NSS and Group RN, respectively.

Conclusion

Nephron sparing surgery causes less damage to renal function in patients with early localized renal tumors than that of radical nephrectomy. Cystatin C, urinary microalbumin and urinaryβ2microglobulin are more sensitive to early detection ofpostoperative renal dysfunction, and may play a synergistic role with creatinine, uric acid and estimated glomerular filtration rate.

Key words: Renal cell carcinoma, Nephrectomy, Renal function
表1 两组患者术前基本资料的比较（±s）
组别 例数 性别（例） 年龄（岁） 肿瘤大小（cm） 肌酐（μmol/L） GFR[ml/（min×1.73m2）]
男 女
保肾组 35 23 12 53±14 4.0±0.6 55±17 100±15
根治组 30 19 11 56±13 3.8±0.7 51±19 101±18
统计值 ? χ2=0.040 t=1.077 t=1.443 t=0.879 t=0.371
P值 ? 0.841 0.286 0.154 0.383 0.712
表2 不同时间保肾组和根治组之间的差异由抽样误差所导致的概率
时间 Scr UA eGFR Cys C mALB β2-MG
术前 0.383 0.825 0.669 0.353 0.791 0.109
术后 0.321 0.153 0.007 0.011 0.252 0.009
术后2 d <0.0010 0.049 <0.0010 <0.0010 0.001 <0.0010
术后6个月 0.356 0.410 0.356 0.287 0.679 0.136
术后12个月 0.614 0.047 0.487 0.111 0.884 0.770
术后18个月 0.634 0.102 0.024 0.208 0.732 0.014
术后2年 0.451 0.230 0.001 0.164 <0.0010 0.001
表3 两组各指标术前与术后24个月之间的差异由抽样误差所导致的概率
组别 Scr UA eGFR Cys C mALB β2-MG
保肾组 0.958 0.007 0.021 0.537 0.554 0.146
根治组 0.945 0.400 0.002 0.005 0.009 0.005
表4 术后两年内各指标独立及联合检测肾功能连续两次异常的概率比较[例（%）]
组别 ① Scr ② UA ③ eGFR ④ Cys C ⑤ mALB ⑥ β2-MG ①+②+③ ④+⑤+⑥ ①+②+③+④+⑤+⑥
保肾组 2（5.7） 6（17.1） 5（14.3） 7（20） 7（20） 8（22.9） 9（25.7） 11（31.4） 13（37.1）
根治组 3（10.7） 7（25） 9（32.1） 13（46.4） 7（25） 6（21.4） 14（50） 17（60.7） 20（71.4）
P值 0.648 0.444 0.090 0.025 0.635 0.892 0.047 0.020 0.007
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